Introduction to Cognitive Behavioural Therapy (CBT)
Introduction to Cognitive Behavioural Therapy (CBT)
Introduction to Cognitive Behavioural Therapy (CBT)
Many people find it fairly easy to think of ways that they can work on improving their physical health. For example, you might go for a walk, listen to your favourite music to make tackling house chores more enjoyable, or even head out to exercise classes. They’re all great ways to stay active and can help you realize benefits through an improved outlook on life and well-being. But when it comes to getting the equivalent “exercise” to improve your mental health, it can be trickier to understand what’s available and what will give you good results.
Cognitive Behavioural Therapy (CBT) is one of many proven therapy techniques. It can help us understand how negative patterns of thinking we have developed throughout our lives make us feel deflated, limited and more fretful. It can help us conquer self-criticism, feeling undervalued, anxiety, depression, low self-esteem, and other common mental health challenges. CBT focuses on identifying negative thought patterns that can often sabotage us and, instead, framing those thoughts differently to unblock our potential and find clarity. After a few sessions with clinicians or online modules, we can become more mindful of our thinking as we learn to embrace different CBT tools.
In this article, we’ll introduce you to some of the principles of Cognitive Behavioural Therapy and help you determine if it might be a type of therapy that you want to try. While it’s not the only type of therapy that can make a difference, it can be a great place to start when you want to work on improving your mental health.
What is Cognitive Behavioural Therapy?
Cognitive Behavioural Therapy (CBT) is a structured and collaborative form of “psychological treatment that…[often] leads to significant improvement in functioning and quality of life.”[1] It helps people recognize when their thinking patterns are distorted and may be contributing to the problems they are experiencing in their lives.
CBT is founded on the core principles that “psychological problems are based, in part, on faulty or unhelpful ways of thinking [and]…learned patterns of unhelpful behaviour.”[2] Additionally, this type of therapy helps people learn “better ways of coping” with their problems so that they become “more effective in their lives.” [3]
CBT helps people move forward from their current difficulties by developing better coping strategies. Working through some history is part of the therapy, but the main focus is to “make sense of what is happening around them and [see how their] perceptions affect the way they feel.”[4]
Why is CBT used?
CBT is a form of therapy because it helps address the thoughts people can get caught up in. Over time, this can affect someone’s outlook on life, making them feel more vulnerable. The methods and exercises we can learn through CBT show us that instead of feeling like we don’t have much influence over the directions our lives are taking, we can modify our thoughts and control how we react to situations. Practicing CBT can change how we feel about daily experiences and problems.
Psychiatrist Aaron Beck developed a model for CBT in 1976. It captured how we “think about things and the content of these thoughts.”[5] Beck’s model expresses three aspects of our thinking and their interrelationship to show how we build negative beliefs:
[6]
CBT is also practical because it is structured and time-limited. People usually attend between 6 and 20 one-hour-long sessions on a regular basis where they focus on a specific problem and work toward achieving specific goals that are agreed to at the start of the therapy.[7] In their sessions, people often feel more engaged in working through their issues because they begin to understand their negative thinking patterns and accept accountability for them. It’s a self-managed way to see how negative thinking influences their behaviour and vice versa: situations trigger automatic thoughts that affect core beliefs. It is also flexible enough to deliver in person, online or through mobile apps.
What is the goal of CBT?
CBT intends to equip someone with a set of practical tools they can use to assess situations they find themselves in that are leading to negative thinking. Some of these tools include:
- Setting SMART (specific, measurable, achievable, realistic, and time-limited) goals can help establish priorities to focus on. Working through and completing small goals helps by building momentum. You get a sense of satisfaction as you achieve things you may have thought impossible.[8]
- Learning to question assumptions and talk through situations with yourself will help you recognize self-criticism. You’ll also learn techniques to “name” what is happening to you when you begin to create “cognitive distortions.” You’ll be able to replace those negative thoughts with constructive ones to be kinder to yourself.”[9]
- Recognizing and learning to modify cognitive distortions. Cognitive distortions create harmful and destructive thinking patterns, which include: jumping to conclusions, always assuming the worst, all -or-nothing thing, always having to be correct, emotional reasoning, blaming, and focusing on what we believe we should have done.[10]
- Keeping a record of your thoughts. People can use tools such as journaling to help identify their negative thoughts and note positive replacements.[11]
- Rewards and incentives focus on creating activities that will improve someone’s overall positivity and mood. [12]
- Situation exposure is a technique used in cognitive behavioural therapy (CBT) to help people identify their fears and approach these fears in a safe, planned and deliberate way. It involves gradually exposing a person to a situation or stimulus that triggers feelings of fear or panic, in a safe space without the intention to cause any danger to the person. Over time, controlled exposure to these fears can help reduce the intensity of anxious or distressing feelings. For example, this tool can give new hope to people suffering from nightmares. Exposure to the situations that create the sense of panic they experience during a nightmare will help them learn that these sensations are not dangerous.[13]
- Mindfulness and relaxation/calming techniques such as deep breathing and muscle relaxation or body scans can help someone develop coping skills to help manage stressful situations and emotions.[14]
Who can benefit from CBT?
Everyone can benefit from CBT. It uses methods like working to understand thoughts and behaviours, using problem-solving skills and increasing confidence. Practicing these will produce changes that are “as effective as, or more effective than, other forms of psychological therapy or psychiatric medications.”[15]
One study revealed that after 5-15 CBT sessions, 50-75% of respondents with social anxiety said that CBT was highly effective.[16] Another series of studies found that when CBT and drug therapy were combined, the results were “superior for major depression, panic disorder and obsessive-compulsive disorder (OCD).”[17]
CBT treatment is effective for various situations, including: bipolar, depression, anxiety, panic attacks, phobias, substance use, PTSD, eating disorders, anger/aggression, relationship problems, trauma, pain, sleep problems, time management challenges, and general or situational stressors.
What to expect in your first CBT session
If you want to explore working with a therapist, your first meeting is a chance to determine how CBT can help you. You will also get a sense of whether you and this therapist have a good fit and can work together.
Here’s what might happen:
- You will determine your preference for a meeting (in person, online, or by phone).
- Your therapist will want to understand why you reached out for help and learn more about your work and personal lives.
- You might discuss costs and time frames/duration of sessions and whether you have coverage under a benefits plan.
- You should discuss the therapist’s background, training, and education.
- Your therapist will review their policy concerning confidentiality.
- Your therapist may ask you what your goals are for therapy so that you can develop a treatment plan together.
- You can discuss how you feel about homework and practicing CBT tools and ask any questions that you may have.
CBT resources
There are many CBT therapy resources available online that you can explore. We’ve included links to a few that you may find helpful. Remember that while CBT has a sizeable self-directed component, it’s always a good idea to consider working with a therapist. They can guide you through the processes and tools so that you understand how it works.
- Thought record worksheet
https://positive.b-cdn.net/wp-content/uploads/2018/01/Thought-Record-Worksheet.pdf
- Accepting Uncertainty Worksheet
- Postponing Your Worries
- Fact-checking thoughts worksheet
https://positive.b-cdn.net/wp-content/uploads/2020/09/Fact-Checking-Thoughts-Worksheet.pdf
- Functional Analysis worksheet
https://positive.b-cdn.net/wp-content/uploads/2020/09/ABC-Functional-Analysis-Worksheet.pdf
What if CBT doesn’t seem like the right fit?
If CBT doesn’t seem right for you, there are alternative therapy options that you can explore such as:
- Behavioural Therapy
There are many other types of behavioural therapy besides CBT. Which one is used depends upon the situation.
- DBT – Dialectical Behavioural Therapy
- Social Learning Theory
- Humanistic Therapy
It focuses on “a person’s individual nature rather than assuming a group of people with similar characteristics have the same concerns.”[18]
- EMDR – Eye Movement Desensitization Therapy
EMDR is used to reduce emotional distress from Post-Traumatic Stress (PTSD).
References:
[1] American Psychological Association (2022). What is Cognitive Behavioral Therapy? APA. Retrieved November 2, 2022 from https://www.apa.org/ptsd-guideline/patients-and-families/cognitive-behavioral
[2] Ibid.
[3] Ibid
[4] Canadian Association for Mental Health (CAMH) (2022). Cognitive behavioural therapy. camh. Retrieved November 2, 2022 from https://www.camh.ca/en/health-info/mental-illness-and-addiction-index/cognitive-behavioural-therapy
[5] Fenn and Byrne (2013). The key principles of cognitive behavioural therapy. Sage Journals: InnovAiT Volume 6, Issue 9, September 2013, Pages 579-585. Retrieved on November 2, 2022 from https://doi.org/10.1177/1755738012471029
[6] Ibid.
[7] Canadian Association for Mental Health (CAMH) (2022). Cognitive behavioural therapy. camh. Retrieved November 2, 2022 from https://www.camh.ca/en/health-info/mental-illness-and-addiction-index/cognitive-behavioural-therapy
[8] Raypole and Marcin (Medically reviewed by Lener, M. MD) (2022, May 17). Cognitive Behavioral Therapy: What Is It and How Does It Work? Healthline. Retrieved November 2, 2022 from https://www.healthline.com/health/cognitive-behavioral-therapy
[9] Ibid.
[10] Riopel, Leslie (2019, June 15). Benefits of CBT: 8+ Results of Cognitive Behavioral Therapy. Positive Psychology.com. Retrieved November 2, 2022 from https://positivepsychology.com/benefits-of-cbt/#:~:text=In%20particular%2C%20the%20strongest%20support,et%20al.%2C%202012).
[11] Raypole and Marcin (Medically reviewed by Lener, M. MD) (2022, May 17). Cognitive Behavioral Therapy: What Is It and How Does It Work? Healthline. Retrieved November 2, 2022 from https://www.healthline.com/health/cognitive-behavioral-therapy
[12] Ibid.
[13] Riopel, Leslie (2019, June 15). Benefits of CBT: 8+ Results of Cognitive Behavioral Therapy. Positive Psychology.com. Retrieved November 2, 2022 from https://positivepsychology.com/benefits-of-cbt/#:~:text=In%20particular%2C%20the%20strongest%20support,et%20al.%2C%202012).
[14] Ibid.
[15] American Psychological Association (2022). What is Cognitive Behavioral Therapy? APA. Retrieved November 2, 2022 from https://www.apa.org/ptsd-guideline/patients-and-families/cognitive-behavioral
[16] Hedman, E., Botella, C, & Berger, T. (2016) Internet-based cognitive behavior therapy for social anxiety disorder. In N. Lindefors & G. Andersson (Eds.), Guided internet-based treatments in psychiatry (pp. 53–78). Springer International Publishing. Retrieved November 2, 2022 from https://doi.org/10.1007/978-3-319-06083-5_4
[17] Cuppers et al., (2014). Adding psychotherapy to antidepressant medication in depression and anxiety disorders: a meta-analysis. World Psychiatry Journal. 2014 Feb; 13(1): 56–67. Published online 2014 Feb 4 doi: 10.1002/wps.20089. Retrieved on November 2, 2022 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3918025/
[18] Psychology Today (n.d.). Humanistic Therapy. Psychology Today. Retrieved November 2, 2022 from https://www.psychologytoday.com/ca/therapy-types/humanistic-therapy
